Endothelial Nitric Oxide Synthase (NOS3) Polymorphisms in African Americans With Heart Failure: Results From the A-HeFT Trial

BackgroundGenetic heterogeneity at the endothelial nitric oxide synthase (NOS3) locus influences heart failure outcomes. The prevalence of NOS3 variants differs in black and white cohorts, but the impact of these differences is unknown.Methods and ResultsSubjects (n = 352) in the Genetic Risk Assessment of Heart Failure (GRAHF) substudy of the African-American Heart Failure Trial were genotyped for NOS3 polymorphisms: –786 T/C promoter, intron 4a/4b, and Glu298Asp and allele frequencies and compared with a white heart failure cohort. The effect of treatment with fixed-dose combination of isosorbide dinitrates and hydralazine (FDC I/H) on event-free survival and composite score (CS) of survival, hospitalization, and quality of life (QoL) was analyzed within genotype subsets. In GRAHF, NOS3 genotype frequencies differed from the white cohort (P < .001). The –786 T allele was associated with lower left ventricular ejection fraction (LVEF) (P = .01), whereas the intron 4a allele was linked to lower diastolic blood pressure and higher LVEF (P = .03). Only the Glu298Asp polymorphism influenced treatment outcome; therapy with FDC I/H improved CS (P = .046) and QoL (P = .03) in the Glu298Glu subset only.ConclusionsIn black subjects with heart failure, NOS3 genotype influences blood pressure and left ventricular remodeling. The impact of genetic heterogeneity on treatment with FDC I/H requires further study.     

Carvedilol心力衰竭研究

标题　Ｃａｒｖｅｄｉｌｏｌ对慢性心力衰竭患者病残率和病死率的影响作者　ＰａｃｋｅｒＭ，ＢｒｉｓｔｏｗＭＲ，ＣｏｈｎＪＮ，等　　ＮＥｎｇｌＪＭｅｄ，１９９６，３３４：１３４９～１３５５　　研究疾病：充血性心力衰竭。目的：Ｃａｒｖｅｄｉｌｏｌ是一种非选择性β受体阻滞剂，它不但具有α１受体阻滞作用，而且具有抗氧化特性。本研究旨在对其对慢性心力衰竭患者存活和住院的影响进行评估。　　设计：随机、双盲、安慰剂对照的多中心研究。病人资料：共１０９４名心力衰竭患者，起病时间≥３月，虽已用利尿剂和ＡＣＥＩ制剂治疗…     

The Ethics of Treating Acute Achilles Tendon Ruptures During the COVID-19 Pandemic: A Case Report

HSS Journal ® -     

Transfusion in surgery and trauma

The role of transfusion in surgery and trauma continues to evolve with our greater understanding of the true indications for and effects of transfusion. The potential adverse immune consequences and end-organ effects of blood transfusion must be weighed against the need for replacement of blood volume and oxygen-carrying capacity. The techniques to conserve blood and avoid transfusion play an important role in caring for the bleeding surgical patient. The future holds great promise for the possibility of redefining the art of blood transfusion and perhaps one day replacing it entirely.